|
Registered Nurse Utilization of Unlicensed
Assistive Personnel
BACKGROUND
The United States is perceived as being
in a crisis with regard to health care: a crisis of cost and coverage. The cost
of health care continues to increase making it more and more expensive for
persons, insurance providers, and employers. Additionally, the number of persons
uninsured and underinsured is growing in this country.
In an effort to solve these problems, the health
care industry and the government are restructuring the way in which health care
is delivered and paid for. As a result of restructuring, the manner in which
Registered Nurses (RN) deliver health care is changing, specifically their
utilization of Unlicensed Assistive Personnel (UAP). Health care providers have
for decades used UAP to provide support for the RN in the delivery of
professional nursing care; however, the role and accountability of UAP has not
been well defined and varies greatly among institutions and health care
settings. UAP who provide support to the RN should never be used as a substitute
for the RN. With restructuring, UAP, in some settings, perform nursing
activities for which they are not trained, educated, or licensed.
DEFINITIONS
Delegation: entrusting to another as
one's representative
UAP: nursing aides, personal care attendants,
family members, friends, appointees of the client
POSITION
The restructuring of health care has
altered the way nursing care is delivered. Registered Nurses are being asked by
health care employers to increase their delegation and use of UAP. This has
resulted in concern for the safety of the patient, the quality of care, and
public welfare. In virtually all health care settings, UAP are being delegated
to and performing duties which are within the scope of nursing. The RN has a
legal scope of practice and a legal authority to perform nursing acts; UAP do
not.
AASCIN believes:
-
The RN should have the protection of the National
Labor Relations Act and states should assure adequate staff to maintain
quality care for different health care settings, e.g., acute care, subacute
care, skilled nursing facilities, and home care.
-
All persons seeking health care are entitled to
be seen and treated by educated competent personnel.
-
The RN is responsible to practice within the
state's Nurse Practice Act and therefore cannot delegate professional duties.
-
Budgetary and resource considerations are not
valid reasons for wrongful delegation.
-
Employers and RNs who participate in wrongful
delegation should be fined or sanctioned, i.e., accreditation or licensure
revoked or suspended.
-
The RN does not have to teach UAP who do not
demonstrate the ability to learn and perform care.
-
UAP who do nursing tasks should be under the
direct supervision of the RN, and the RN must participate with authority in
the evaluation of UAP.
-
UAP should not be used as a substitute for
the RN in providing nursing care.
-
UAP function differently in different
health settings and may not be subject to the same legal mandates in all
settings. In licensed settings, UAP are subject to state license restrictions.
In settings not subject to licensed regulation, where UAP are arranged
for by the client or the client's agent, the UAP works as the client's
UAP, and the UAP's care and supervision are the responsibility
of the client or client’s agent.
-
At the request of the client or client's agent,
the RN may teach the client's care to UAP. The client or client's agent then
accepts responsibility for the UAP's supervision and the type and
quality of care the UAP provides. The exception to this would be when
the UAP are supplied through an agency; in this situation the UAP would
be subject to the regulations of the agency and state. Ideally, the RN teaches
the client who then teaches and delegates his/her care to their UAP.
REFERENCES
American
Nurses Association. Position Statement on Registered Nurse Utilization of
Unlicensed Assistive Personnel, Washington DC. 1992.
Emergency Nurses Association. Position Statement on
the Use of Non-Registered Nurse Caregivers in Emergency Care, Chicago IL.
1993.
Association of Rehabilitation Nurses. Position
Statement on the Registered Nurse Utilization of Unlicensed Assistive Personnel,
Skokie IL. 1994.
(approved 9/95) |
